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. 2022 Aug;42(4):355-363.
doi: 10.14639/0392-100X-N1800. Epub 2022 Jun 30.

Calprotectin in nasal secretion: a new biomarker of non-type 2 inflammation in CRSwNP

Eugenio De Corso  1 , Silvia Baroni  2   3 , Maria Elisabetta Onori  3 , Laura Tricarico  3 , Stefano Settimi  1 , Giacomo Moretti  3 , Eliana Troiani  3 , Rodolfo Francesco Mastrapasqua  3 , Daniela Furno  3 , Fabrizio Crudo  3 , Andrea Urbani  2   3 , Jacopo Galli  1   3
Affiliations

Calprotectin in nasal secretion: a new biomarker of non-type 2 inflammation in CRSwNP

Eugenio De Corso et al. Acta Otorhinolaryngol Ital. 2022 Aug.

Abstract
in English, Italian

Objective: We analysed calprotectin in sinonasal secretions of different chronic rhinosinusitis with nasal polyps (CRSwNP) endotypes to assess its role as a biomarker of non-type 2 inflammation.

Methods: We included primary diffuse CRSwNP patients (n = 41) and three different control groups [non-allergic rhinitis (NAR) (n = 13), non-allergic eosinophilic syndrome (NARES) (n = 10) and healthy subjects (n = 12)]. Calprotectin levels were detected in nasal secretions using a chemiluminescent immunoassay (CLIA).

Results: Calprotectin levels in nasal secretions were significantly higher in all non-type 2 endotypes of CRSwNP compared to healthy controls (p < 0.05). In contrast, in type-2 CRSwNP calprotectin was significantly lower compared to controls (p < 0.05). A significant correlation between calprotectin levels and neutrophilic count/HPF was found in CRSwNP (p < 0.01). Clinically, mean levels of calprotectin and neutrophilia were significantly higher in patients who previously underwent 3 or more endoscopic sinus surgeries (p < 0.05).

Conclusions: Calprotectin in nasal secretions may be a biomarker of non-type 2 inflammation. Low levels of calprotectin are indicative of a type-2 immune response in both CRSwNP and non-allergic rhinitis. We observed that calprotectin levels significantly increased based on the number of previous surgeries.

Calprotectina nel secreto nasale: nuovo biomarker di infiammazione non-tipo 2 nella poliposi nasale.

Obiettivo: Abbiamo analizzato i livelli di calprotectina nelle secrezioni nasali di diversi endotipi di CRSwNP, per valutarne il ruolo di marcatore di infiammazione non-tipo 2.

Metodi: Abbiamo incluso pazienti con CRSwNP diffusa primaria (n = 41) e tre diversi gruppi di controllo [rinite non allergica (NAR) (n = 13), rinite eosinofila non allergica (NARES) (n = 10) e soggetti sani (n = 12)]. I livelli di calprotectina sono stati dosati mediante test di chemoluminescenza.

Risultati: I livelli di calprotectina sono risultati significativamente più alti in tutti gli endotipi non-tipo 2 di CRSwNP, rispetto ai controlli sani (p < 0,05). Al contrario, nella CRSwNP tipo 2 essa è risultata inferiore rispetto ai controlli (p < 0,05). È stata riscontrata una correlazione significativa tra i livelli di calprotectina e la conta dei neutrofili/HPF (p < 0.01). I livelli medi di calprotectina aumentano inoltre nei pazienti in precedenza sottoposti a 3 o più ESS (p < 0,05).

Conclusioni: La calprotectina nelle secrezioni nasali può essere considerata un biomarcatore di infiammazione non-tipo 2 mentre bassi livelli di calprotectina sono indicativi di immunoflogosi di tipo 2. Abbiamo infine osservato che i livelli di calprotectina aumentano significativamente in relazione al numero di interventi chirurgici pregressi.

Keywords: immunophenotyping; nasal polyps; precision medicine; rhinitis; sinusitis.

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Figures

Figure 1.
Figure 1.
Box plots showing mean levels of calprotectin (ng/ml) based on CRS endotyping. The box plot shows the median and interquartile range and the error bars show the 5th and 95th percentiles. Statistical significance is given as p < 0.05.
Figure 2.
Figure 2.
Scatter plot showing intra-individual correlations between calprotectin and neutrophil count/HPF in all patients (NAR; NARES and CRSwNP) excluding healthy subjects (rs = correlation coefficient assessed by Spearman’s rank correlation test. Statistical significance is given as p < 0.05).
Figure 3.
Figure 3.
Scatter plot showing intraindividual correlations between calprotectin and neutrophil count/HPF in CRSwNP patients (rs = correlation coefficient assessed by Spearman’s rank correlation test). Statistical significance is given as p < 0.05).
Figure 4.
Figure 4.
Box plot showing mean levels of calprotectin (ng/ml) of CRSwNP patients based on the number of previous endoscopic sinus surgery performed. The box plot shows the median and interquartile range and the error bars show the 5th and 95th percentiles.
Figure 5.
Figure 5.
Box plots showing mean levels of calprotectin (ng/ml) in nasal secretions (NAR: non-allergic rhinitis; NARES: non-allergic eosinophilic syndrome; CRSwNP chronic rhinosinusitis with nasal polyps). The box plot shows the median and interquartile range and the error bars show the 5th and 95th percentiles. Statistical significance is given as p < 0.05.
See this image and copyright information in PMC

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